1. SMART: Social/Mobile Approach to Reduce WeighT – Evaluation Challenges Greg Norman Department of Family & Preventive Medicine Center for Wireless and Population Health Systems, Calit2 Mobile Health 2011
2. Study Team | Slide 2 Kevin Patrick, MD, MS Greg Norman, PhD Simon Marshall, PhD Cheryl Rock, PhD RD Jeannie Huang, MD MS James Fowler, PhD Bill Griswold, PhD Tom Robinson, MD, MPH BJ Fogg, PhD Fred Raab Anjali G. Kansagara, MS, MBA Aaron Coleman Melanie Epstein-Corbin, MPH Evan Cook Jeff Chang Ernesto Ramirez, MS Laura Pina Kendra Markle
3. Objectives for Today Describe the SMART study. Describe ‘active ingredients’ of program. Describe the challenges of evaluating the intervention.
4. SMART Social Mobile Approach to Reduce Weight PURPOSE To leverage mobile phones, social networks,and the web for weight loss among 18-35 year old young adults. Funded with a 5-year grant from NHLBI/NIH.
20. Recommended Trends are “triggers” or reminders of strategies to practice for that week’s theme
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22. Be Healthy A healthy tip a day keeps the doctor away. Healthy Tips that are acted upon can be shared with others…
23. Facts & Quizzes SMART | Slide 15 A knowledge app to help learn and recall key facts. Throughout the intervention we hope to improve knowledge about energy intake, energy expenditure, calorie counting and overall understanding of diet, PA and sedentary influences on weight
40. Downside – could have negative impact nature of intervention and what we can learn.
41. Upside – could improve delivery of intervention and what we can learn.
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Editor's Notes
Multi disciplinary team – public health, exercise science, nutrition, medicine, computer science, political science
2. Active ingredients are the ‘what works’ or the evidence-based strategies for behavior change. 3. Specifically, challenges to conducting a randomized controlled trial with this type of intervention. And I’ll explain that as we go.Hopefully will show that in some ways the study is like a typical RCT and in other ways it is not.
NHLBI had call for proposals specifically focusing on young adult weight loss – since this is considered an under researched population segment and one in need of intervention programs for weight loss and weight maintenance. One of the stipulations was the intervention program had to last 2 years.
In some ways the study is a standard two group RCT…
CampusExpect roughly 40 40 10 10% Total400Females not to exceed 70%Males at least 30%Hispanics not to exceed 30% at SDSUAsians not to exceed 30% at UCSDAge as evenly distributed as possible across 18-35 year oldsBMI 25-34.9
In person measurements every 6 months – again pretty standard for a community-based RCT
Three-two me concept I’ll explain in just a second.The program contains16-week (modules)of contentThe 16-week program repeated five times in the course of 2-year Participants don’t need to have a Smart phone and can still get all the content and tools. -this decision was a trade-off between real world generalizability OR limiting the sample to those with smart phones for a more controlled study
ThreeTwoMe – has multiple meanings:-Three degrees of influence-Small steps to a better me-Stepped approach to health-Personal. Social. Global. – influences and interactionsWe are not intending to create a social net among the study participants. We want users to engage their own social network to get support for changing behavior and weight loss.
These are our ‘active ingredients’ – the behavior change strategies that we know are important for physical activity and diet.Self-monitoring found to be most importantSelf-monitoring plus one other technique even betterIntention formation – making a commitment - from attitudes, beliefs, previous experience – aka Readiness to change, ‘stages of change’ Underlying TheoriesSocial Cognitive TheoryControl Theory - Operant LearningEcological Models
Each app adds the social network connectionsto the behavior change strategies. -social norms and accountability, praise, social statusJquiry to build apps
Based on the ‘Do Good’ app.
-Design randomized two group (treatment & control) – assessments every 6 months.First challenge is 2 year intervention that will change over time – not ‘locking down’ program and standardizing for course of the intervention.
Second challenge is controls gain access to intervention, ‘contamination’.Do we try to control contamination?
Third challenge is whether or not participants will become friends on FB because of program. Can measure friendship ties and determine extent of clustering, We don’t anticipate significant clustering, previous studies have shown that people don’t tend to become friends through FB.
So I will end here, and welcome discussion on these issues.
